title: The risk of headache attributed to surgical treatment of intracranial aneurysms: a cohort study.
abstract: OBJECTIVE
  The aim of this study was to assess the risk of headache in patients undergoing surgical treatment of intracranial aneurysms.
  
  
  BACKGROUND
  The risk of the post-craniotomy headache has never been studied.
  
  
  METHODS
  Patients with intracranial aneurysm, who were consecutively admitted to the Hospital da Restauração, Brazil, from May 2009 to October 2010, were interviewed before they underwent surgical or non-surgical treatment of the aneurysms. The patients were followed for 4 months after intervention. The International Headache Society criteria for post-craniotomy headache were used after surgery and adapted for headache after embolization (maximum intensity of pain on the same side of the aneurysm). We also used the Headache Impact Test, the Hospital Anxiety and Depression Scale, and the Epworth Sleepiness Scale.
  
  
  RESULTS
  Of 101 patients enrolled, 53 patients underwent craniotomy and 48 patients embolization. The surgery group was younger and had fewer women. The incidence of headache was 28/51 cases (54.9%) after surgery and 12/47 cases (25.5%) after embolization (relative risk = 2.15; 95% confidence interval [CI] 1.24-3.72). The incidence of persistent headache was not different between the 2 groups. The only risk factor for headache after the intervention was craniotomy (odds ratio = 2.6; 95% CI 1.1-6.7) and for persistent headache was anxiety prior to treatment (odds ratio = 8.5; 95% CI 1.7-42.3). The headache after treatment was not associated with the risk of anxiety or depression after the intervention.
  
  
  CONCLUSIONS
  Patients who underwent craniotomy had an increased risk of headache after treatment of intracranial aneurysms. The incidence of persistent headache after 3 months was higher among patients who had anxiety before the intervention.
authors.affiliation: Division of Neurology, Hospital Universitário Oswaldo Cruz, Universidade de Pernambuco, Recife, PE, Brazil.
authors.forename: João E
authors.initials: JE
authors.lastname: Magalhães
authors.forename: Hildo R C
authors.initials: HR
authors.lastname: Azevedo-Filho
authors.forename: Pedro A S
authors.initials: PA
authors.lastname: Rocha-Filho
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003399:Craniotomy / Q000009:adverse effects*; D005260:Female; D006261:Headache / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D002532:Intracranial Aneurysm / Q000453:epidemiology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology*; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: craniotomy; embolization; headache; intracranial aneurysm; risk